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Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding.

Publication ,  Journal Article
Tanaka, KA; Szlam, F; Kelly, AB; Vega, JD; Levy, JH
Published in: Platelets
August 2004

The use of clopidogrel (Plavix), an inhibitor of adenosine diphosphate (ADP)-induced platelet aggregation, has been proven to reduce ischemic events in cardiovascular patients, but little information is available for optimal monitoring of platelet function in patients receiving the drug preoperatively. In the first part of the study we compared different testing modalities (thrombelastography (TEG), platelet aggregometry, and whole blood aggregation) to assess platelet ADP receptor inhibition. Because clopidogrel is a pro-drug, we used an in vitro model of ADP inhibition with 5'-p-fluorosulfonylbenzoyladenosine (FSBA). FSBA at final concentration of 80 microM completely inhibited platelet aggregation but had no effect on TEG maximum amplitude (MA). In the second part of the study, antiplatelet effects of clopidogrel were clinically assessed and correlated to postoperative bleeding in 18 coronary bypass surgery patients. Preoperative TEG results were normal or hypercoagulable in clopidogrel-treated patients, although platelet aggregation responses to ADP were inhibited. Clopidogrel-treated patients who underwent cardiopulmonary bypass had a high incidence (84.6%) of platelet transfusion therapy due to increased chest tube drainage. In conclusion, we have demonstrated that normal preoperative TEG-MA does not preclude clopidogrel-induced ADP receptor blockade; however, TEG can be a reliable monitor for CPB-induced platelet dysfunction related to GPIIb/IIIa. For monitoring clopidogrel, it is necessary to perform more specific platelet function tests (aggregometry or platelet count ratio) using ADP as an activator.

Duke Scholars

Published In

Platelets

DOI

ISSN

0953-7104

Publication Date

August 2004

Volume

15

Issue

5

Start / End Page

325 / 332

Location

England

Related Subject Headings

  • Time Factors
  • Ticlopidine
  • Thrombelastography
  • Retrospective Studies
  • Purinergic P2 Receptor Antagonists
  • Postoperative Hemorrhage
  • Platelet Function Tests
  • Platelet Aggregation
  • Middle Aged
  • Male
 

Citation

APA
Chicago
ICMJE
MLA
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Tanaka, K. A., Szlam, F., Kelly, A. B., Vega, J. D., & Levy, J. H. (2004). Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding. Platelets, 15(5), 325–332. https://doi.org/10.1080/09537100410001710236
Tanaka, Kenichi A., Fania Szlam, Andrew B. Kelly, J David Vega, and Jerrold H. Levy. “Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding.Platelets 15, no. 5 (August 2004): 325–32. https://doi.org/10.1080/09537100410001710236.
Tanaka KA, Szlam F, Kelly AB, Vega JD, Levy JH. Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding. Platelets. 2004 Aug;15(5):325–32.
Tanaka, Kenichi A., et al. “Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding.Platelets, vol. 15, no. 5, Aug. 2004, pp. 325–32. Pubmed, doi:10.1080/09537100410001710236.
Tanaka KA, Szlam F, Kelly AB, Vega JD, Levy JH. Clopidogrel (Plavix) and cardiac surgical patients: implications for platelet function monitoring and postoperative bleeding. Platelets. 2004 Aug;15(5):325–332.
Journal cover image

Published In

Platelets

DOI

ISSN

0953-7104

Publication Date

August 2004

Volume

15

Issue

5

Start / End Page

325 / 332

Location

England

Related Subject Headings

  • Time Factors
  • Ticlopidine
  • Thrombelastography
  • Retrospective Studies
  • Purinergic P2 Receptor Antagonists
  • Postoperative Hemorrhage
  • Platelet Function Tests
  • Platelet Aggregation
  • Middle Aged
  • Male